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Better Public Health Working in Partnership with Sports and Physical Activity Sector Jim McManus Director of Public Health 26th February 2014 Sports and Physical Activity Stakeholder Event Hertfordshire Sports Village www.hertsdirect.org

AGENDA • 9.30am – Welcome and introduction Christine Neyndorff Director, Herts Sports Partnership (HSP) • 9.35am Herts Public Health Strategy – ‘working in partnership with the sport sector • Jim McManus Director of Public Health, HCC • 10.05am Q&A / discussion Jim McManus • 10.50am • • • • • • Sport & PA case studies – the use of sport and physical activity to promote public health messages Fiona Deans, Herts Sports partnership 11.00am In groups, identify Fiona Deans What can the Sport & PA sector do as part of what they do anyway? What is needed to help this happen? What would be a priority for new work? • 11.25am • 11.30am Closing remarks End of session www.hertsdirect.org Christine Neyndorff

Current challenges facing Hertfordshire • Avoidable early deaths – over 2,000 pa • Chronic disease – poor self management, poor • • • management of sub-clinical risk, could do better on prevention and early intervention Some sections of our population at very high risk of avoidable misery and death Mental health – haven't tapped the benefits of physical activity for this Resilience and Happiness – likewise www.hertsdirect.org

Healthier Herts: A Public Health Strategy for Hertfordshire OUR PURPOSE to work together to improve the health and wellbeing of the people of Hertfordshire, based on best practice and best evidence OUR VISION: A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives. We compare well with England and every area in Hertfordshire compares well against Hertfordshire The Public Health Outcomes Framework (the national PHOF will Help us measure Our success) WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUR RESIDENTS (our strategic priorities: what we achieve for our County) Priority 1: Our Populatio n lives Longer, Healthier Lives Building Strong Blocks Leadership For the Public Health Family Priority 2: Our Population Starts Life Healthy and Stays Healthy Capable, Skilled People www.hertsdirect.org Priority 3: We narrow the gap in life expectancy and health between most and least healthy Co-production with citizens Priority 4: We protect our communities from harm (chemical, biological, radiological and environmental) Effective Partnerships HOW WE WILL WORK TOGETHER (our strategic priorities: how we do it for our County) Priority 5: We understand what’s needed and we do what works Evidence and Knowledge Driven Plan and Deliver for Localism Priority 6: We make public health everybody’s business and work together Whole System Approaches Making better use of behavioural sciences at individual, interpersonal, community and service levels

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Contributors to overall health outcomes and why elected councillors are important leaders Health Behaviours 30% Socioeconomic Factors 40% Clinical Care 20% Built Environment 10% Smoking 10% Education 10% Environmental Quality 5% Diet/Exercise 10% Employment 10% Access to care 10% Quality of care 10% Built Environment 5% Alcohol use 5% Poor sexual health 5% www.hertsdirect.org Income 10% Family/Social Support 5% Community Safety 5% Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. Used in US to rank counties by health status While this is from a US context it does have significant resonance with UK Evidence, though I would want to increase the contribution of housing to health outcomes from a UK perspective.

Hertfordshire doing very well overall, but this masks several districts with Significant inequalities in outcomes www.hertsdirect.org

How? • Self management in primary care and chronic disease • Benefits of physical activity • Behavioural support and change (variety of techniques) • Early identification of people with disease and pathwaying into healthier lifestyles www.hertsdirect.org

• • • • • • • • It is not the answer to obesity, it is part of AN answer It is important in and of itself as a health-giving and health-protecting exercise (vascular, endocrine, musculo-skeletal, cognitive, emotional and immune benefits) Second nature self-propelled transport Link up to behavioural pathways in prevention Balances pharmacological pathways in prevention of non communicable disease Supports self care in non communicable disease Supports tehabilitation Mental health resilience and coping www.hertsdirect.org

a new approach is needed, focus on shifting weight distribution in the population Underweight Healthy weight Overweight Obese Average BMI Maximise proportion at a healthy weight Minimise proportion at an unhealthy weight Fewer overweight Fewer underweight Fewer obese www.hertsdirect.org Average BMI Reduce average BMI Underweight Healthy weight Overweight Obese Make more people a healthy weight, not just fewer people obese

Systems thinking on wider determinants Getting everyone on the same systems page The wider determinants of Health and Local Government functions (Must adopt a Lifecourse approach!) The Lives people lead and whether LA functions help or hinder healthy lifestyles (policy, service quality, access, behavioural economics, behavioural sciences) The services people access such as primary care (high quality, easy access, good follow up, behavioural and lifestyle pathways wrap around) www.hertsdirect.org

Some parameters – yes please to • Physical activity population wide as an important public • • health intervention Targeted and tailored interventions for populations – Health walks – Cardiac rehabilitation phases 1 – 4 – Secondary prevention – Post surgery rehabilitatipn – Better access for disabled people Range of benefits – physical and psychological – “Everybody more active, more of the time” – Everyone working out their role and contribution www.hertsdirect.org

Some parameters • No to assuming physical activity is “the solution” • to obesity (because it simply isn’t) Need to work out the role of elite sports and our sports clubs in public health challenges – Suggestion – their public health role is about • doing what they do already • Increasing participation at all levels • Helping create a culture of physical activity • They are a part of an answer, not the answer www.hertsdirect.org

Values for sports and physical activity sector Ottawa Charter, 1986 • "The goal of a healthy public policy is health promotion, i.e., to enable people to increase control over and improve their health. • It is also essential to – – – – create supportive environments, strengthen community action, develop personal skills and reorient health services. All of these are area where sports and physical activity can help www.hertsdirect.org

The upshot of the Ottawaw Charter for sport and physical activity • Regular physical activity available for ALL as routine part of life • Physical activity providers as part of public health pathway • Making every contact count • Physical Activity Plus + • Sport from entrant to elite – social norms reinforcing activity and health www.hertsdirect.org

What it means for NHS Services, for example • Preventive services in every patient pathway • Preventive services in clinical services link up to community services (referral for leisure and behavioural interventions) • Making Every Contact Count • Commissioning for self-management in chronic disease www.hertsdirect.org

What it means for physical activity agencies • Mainstream an ethos of public health in your service • Co-design public health services with public health commissioners • Embed public health skills across your services • Build resilience in users and communities • Motivate people to self-manage • Become health promoting in all you do www.hertsdirect.org

Phasing and Layering across public health •Think through what we can do short term •Start work on the medium term •Set the policy framework for the long term •Build this understanding among partners •Get started and realise •County, District, Parish, NHS, Business and Community Sector working together www.hertsdirect.org

A Lifecourse approach to physical activity • Everyone active from early years to older age • Tailored menu of what can be done • School, community, workplace, care setting www.hertsdirect.org

15 Actions being taken so far (more will be done) 1. New weight management service already 1st 2. 3. 4. 5. 6. 7. commissioned and reached 1,000 referrals in three months, more will be commissioned Obesity pathway in place for tiers 1 -3 obesity care. Revision late 2014 New lifestyle partnership launched with lifestyle offer for Herts residents to be ready by Easter for phased roll out New online lifestyle service launched in February Workplace physical activity challenge funded and running (Herts Sports Partnership) Workplace Health improvement programme running (Business in the Community) 93% of GPs in Herts now doing NHS HealthChecks www.hertsdirect.org 1. Obesity Plan approval by Cabinet due March 2014 2. New child weight management service to be commissioned in 2014 3. Broxbourne whole area obesity pilot underway with Borough and County Council, schools and NHS 4. Fast food takeaway restrictions 5. Countryside walks scheme 6. Year of Cycling launching May 2014 7. Funding for District Councils to work on health improvement agreed and each District working out its plans 8. Continue child weight measurement programme

Behaviour Change Pathway Approaches The evidence base for changing health behaviour is developing quickly. Brief interventions in primary care (by practice nurses and GPs) can motivate people to change, providing referral onwards is speedy. This pathway 1st Line – Brief Intervention Opportunistic brief advice by GP, pharmacist or practice nurse 1Identify health issue of concern (and follow appropriate pathway for that, e.g. obesity) 2Assess motivation to change 3If motivated, refer on 4If not motivated, Raise awareness of risks. Offer written information on healthy eating and physical activity. Raise again in 3 months. Offer information prescription 2nd Line – Behaviour Change Discuss primary or main goal then refer appropriately Smoking is primary, main or only goal Refer to smoking cessation service www.hertsdirect.org Weight loss, healthy living or CVD risk is main or primary goal Refer to ifestyle Service 3rd Line - Activity 4th Line – Specialist If fall into 1st or subsequent line category of advice within Obesity Care Pathway refer to Lifestyle Programme, provided there are no contraindications and if co-morbidities or person has BMI over 30, GP has assessed and supports referral. Check this …. For patients with comorbidites Patients who are diabetic or have coronary heart disease or a history of heart problems must have referral from appropriate primary care team or secondary care to participate in programme. Behaviour change programme to be developed in partnership with specialist services Patients with highly complex psychological or emotional issues (e.g. depression or eating disorder.) If not already in contact with such services, refer to IAPT programme psychology or primary care mental health team

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